18,348 research outputs found
Evaluation of a Phosphate Management Protocol to Achieve Optimum Serum Phosphate Levels in Hemodialysis Patients
Original article can be found at: http://www.sciencedirect.com/science/journal/10512276 Copyright National Kidney Foundation, Inc. DOI: 10.1053/j.jrn.2008.05.003To evaluate the effectiveness of a protocol designed to optimize serum phosphate levels in patients undergoing regular hemodialysis (HD).Peer reviewe
Assessing housing quality and its impact on health, safety and sustainability
Background The adverse health and environmental
effects of poor housing quality are well established. A
central requirement for evidence-based policies and
programmes to improve housing standards is a valid,
reliable and practical way of measuring housing quality
that is supported by policy agencies, the housing sector,
researchers and the public.
Methods This paper provides guidance on the
development of housing quality-assessment tools that
link practical measures of housing conditions to their
effects on health, safety and sustainability, with
particular reference to tools developed in New Zealand
and England.
Results The authors describe how information on
housing quality can support individuals, agencies and the
private sector to make worthwhile improvements to the
health, safety and sustainability of housing. The
information gathered and the resultant tools developed
should be guided by the multiple purposes and end users
of this information. Other important issues outlined
include deciding on the scope, detailed content, practical
administration issues and how the information will be
analysed and summarised for its intended end users.
There are likely to be considerable benefits from
increased international collaboration and standardisation
of approaches to measuring housing hazards. At the
same time, these assessment approaches need to
consider local factors such as climate, geography,
culture, predominating building practices, important
housing-related health issues and existing building
codes.
Conclusions An effective housing quality-assessment
tool has a central role in supporting improvements to
housing. The issues discussed in this paper are designed
to motivate and assist the development of such tools
Chromosome 9p deletion in clear cell renal cell carcinoma predicts recurrence and survival following surgery
BACKGROUND: Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC. METHODS: Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival. RESULTS: There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001). CONCLUSIONS: Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion
Preregistration house officers in general practice: review of evidence
OBJECTIVES: To examine the strengths and weaknesses
of the national and local schemes for preregistration
house officers to spend four months in general
practice, to identify any added value from such
placements, and to examine the impact on career
choices.
DESIGN: Review of all studies that reported on
placements of preregistration house officers in
general practice.
SETTING: 19 accounts of preregistration house officers’
experience in general practice, ranging from single
case reports to a national evaluation study, in a variety
of locations in Scotland and England.
PARTICIPANTS: Views of 180 preregistration house
officers, 45 general practitioner trainers, and 105
consultant trainers.
MAIN OUTCOME MEASURES: Main findings or themes
weighted according to number of studies reporting
them and weighted for sample size.
RESULTS: The studies were unanimous about the
educational benefits of the placements. The
additional learning included communication skills,
social and psychological factors in illness, patient
centred consultations, broadening of knowledge base,
and dealing with uncertainty about diagnosis and
referral.
CONCLUSIONS: Despite the reported benefits and
recommendations of the scheme, it is not expanding.
General practitioner trainers reported additional
supervision that was unremunerated. The reforms of
the senior house officer grade may resolve this
problem by offering the placements to senior house
officers, who require less supervision
Landslides in sensitive soils, Tauranga, New Zealand.
In the Tauranga region sensitive soil failures commonly occur after heavy rainfall events, causing considerable infrastructure damage. Several notable landslides include a large failure at Bramley Drive, Omokoroa in 1979, the Ruahihi Canal collapse in 1981, and numerous landslides in May 2005; recently the Bramley Drive scarp was reactivated in 2011. These failures are associated with materials loosely classified as the Pahoia Tephras - a mixture of rhyolitic pyroclastic deposits of approximately 1 Ma.
The common link with extreme rainfall events suggests a pore water pressure control on the initiation of these failures. Recent research on the structure of the soils shows a dominance of halloysite clay minerals packed loosely in arrangements with high porosity (51 – 77 %), but with almost entirely micropores. This leads us to conclude that the permeability is very low, and the materials remain continuously wet. The formation of halloysite is encouraged by a wet environment with no episodes of drying, supporting this assumption.
A high-resolution CPT trace at Bramley Drive indicates induced pore water pressures rising steadily to a peak at approximately 25 m depth; this depth coincides with the base of the landslide scarp. We infer that elevated pore water pressures develop within this single, thick aquifer, triggering failure through reduced effective stresses. The inactive halloysite clay mineral results in low plasticity indices (13 – 44 %) and hence high liquidity indices (1.2 – 2.4) due to the saturated pore space; remoulding following failure is sudden and dramatic and results in large debris runout distances
Design of the Annular Suspension and Pointing System (ASPS) (including design addendum)
The Annular Suspension and Pointing System is an experiment pointing mount designed for extremely precise 3 axis orientation of shuttle experiments. It utilizes actively controlled magnetic bearing to provide noncontacting vernier pointing and translational isolation of the experiment. The design of the system is presented and analyzed
- …